Ticket for Outdoor Patient
| Ward No. 10 | U-PHC No. | Registration No. 01292 | Date 20/11/2018 |
| Token No | SM/18-19/4109 11/06/2019 | Serial | 040 |
| Patient Name | Mrs. NISHA ROY | Contact No | 9874754179 |
| Address | 3 L B S ROAD, SERAMPORE | Age | 55 Female |
| Token For | Pathology Test | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||